Endoscopic spine surgery (ESS) is an effective treatment option for individuals seeking pain relief from a disc tear or herniated disc irritating or compressing the spine. ESS can relieve chronic back, neck, and leg pain, treating painful medical issues with minimal risks and complications. Being a minimally invasive procedure, people have shorter recovery periods and feel better sooner than with other spinal surgery techniques.
ESS is available at Robert Porter, M.D. in Phoenix and the surrounding area. You do not have to live with chronic back pain. Call us today at (602) 603-8951 to learn more about our services or schedule a consultation.
Endoscopic spine surgery (ESS) is a minimally invasive surgical procedure that provides relief from chronic back pain. Unlike open back surgery, ESS allows access to the spinal network through a tiny opening. Dr. Porter uses a small camera (endoscope) and specialized micro-instruments to access the patient’s spine. They create a small incision that helps avoid surrounding muscles and tissue while allowing access to reach and view the affected area.
While ESS has been mainly applied to treat issues that affect the lumbar spine, its use has extended to treat the whole spine, including the cervical spine (neck) and thoracic spine (upper back). It can also treat several conditions that affect the spinal canal. These conditions may include:
In addition, ESS can decompress spinal nerves, giving patients relief from chronic back pain.
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Minimally invasive spine surgery (MISS) is the standard of care in spinal surgery and represents a wide range of surgical techniques. Endoscopic spine surgery is the least invasive under this treatment umbrella. The ESS procedure has similar results to the MISS microdiscectomy procedure for relieving painful spine conditions.
However, in contrast to MISS, ESS reduces trauma to the patient’s muscles and soft tissue, which helps them have a faster recovery. The endoscopic procedure utilizes a surgical approach that avoids interacting with the major stabilizing muscles of the lower back. ESS also uses a ¼ inch incision compared to the MISS incision of one inch or more. Smaller surgical incisions help avoid postoperative complications and improve the patient’s overall treatment outcome.
With various types of endoscopic spine surgery available, the one chosen will depend on the patient’s treatment needs and preferences. The types of ESS include:
Endoscopic laminotomy
This type of endoscopic spine surgery is suitable for patients with lumbar spinal stenosis who have not responded to traditional treatment options. In lumbar spinal stenosis, the spinal canal narrows around the spine, exerting pressure on the nerves and spinal cord. During this procedure, the surgeon opens the lamina below and above the spinal disc to decompress the nerve.
Endoscopic rhizotomy
An endoscopic rhizotomy is a type of ESS that can provide relief for patients experiencing muscle spasms or lower back pain. This discomfort is often caused by the medial branch nerve, which extends from the nerve roots of the spinal cord. The medial branch nerve can sometimes send faulty pain signals to the brain. During an endoscopic rhizotomy, the surgeon uses a laser to sever the problematic nerve root, cutting off pain signals from the back to the brain.
Endoscopic foraminoplasty
Endoscopic foraminoplasty is a type of ESS that relieves pressure that directly affects the spinal cord or a surrounding nerve, which may be caused by scar tissue, bone spurs, or a herniated disc. This procedure uses microscopic surgical equipment to extract part of the bone and open the foramen, relieving pressure on the patient’s spinal nerves.
Transforaminal endoscopic discectomy
A transforaminal endoscopic discectomy can relieve the pain caused by bulging or herniated discs. This procedure involves using an endoscope to decompress the disc, relieving the pressure on the spinal nerves causing chronic back pain.
Endoscopic annuloplasty
For patients with tears in the walls of a spinal disc, an endoscopic annuloplasty can treat the nerves in the disc, providing relief without the need for spinal fusion. This procedure uses the endoscope to look for tears, treating them with laser light to clip the nerves and close the tear.
Many patients who are candidates for endoscopic spine surgery have been diagnosed with common types of spinal disorders. However, no treatment is identical from patient to patient. Each surgical plan varies on a case-by-case basis. Patients who are interested in endoscopic spine surgery should talk to Dr. Porter about their specific condition, overall health, lifestyle, and treatment goals. These factors can help determine if the patient qualifies for endoscopic spine surgery.
It is also important to remember that endoscopic spine surgery is typically most effective for patients whose condition has not progressed too far and who have not experienced relief from more conservative treatments like medication and physical therapy. Individuals with more severe cases that affect multiple vertebrae may benefit more from an open spine surgery. As with any medical procedure, it is always best to seek the professional guidance of a qualified medical professional before making any final decisions about one’s health.
Before the surgery begins, Dr. Porter will slightly sedate the patient with intravenous medication. Due to the minimally invasive nature of ESS, general anesthesia is typically not necessary. They will then numb the skin in the treatment area to ensure the patient is comfortable throughout the procedure. Depending on the patient’s specific diagnosis, it may be necessary to access the spine using one of two approaches: intralaminar (between two laminae) or transforaminal (from the back or side of the spine through the neuroforamen).
Once the patient is sedated and numb, the surgeon will make a small incision and carefully separate the muscles to create a small pathway for the endoscope to reach the spinal canal. The next step is to insert a trocar (about the width of a pencil), which allows a pathway for the endoscope. This tiny camera allows the surgeon to capture images to project them on an external monitor, giving them a clear image of the patient’s pathology and anatomy.
Through a hollow channel within the camera, surgical instruments are inserted to relieve pressure on the affected nerve. This often means resecting thickened ligaments, herniated discs, or hard bone spurs to relieve pressure on the nerves. By the end of the procedure, the surgeon will have removed all sources of nerve compression.
Once the procedure is over, the surgeon removes the endoscopic camera and trocar. They then return the muscles and other soft tissues to their natural positions. The incision is closed with a stitch beneath the skin and protected with a small bandage to prevent postoperative infection.
You do not have to live with chronic back pain. Endoscopic spine surgery is a minimally invasive procedure that repairs issues that affect the spine while reducing your recovery time. Our team at Randall Porter, M.D. can determine if you qualify for this treatment. Call our Phoenix office at (602) 603-8951 to learn more about our services or to schedule a consultation.
What is the recovery time for endoscopic spine surgery?
Recovery from endoscopic spine surgery depends on the patient’s unique condition, its severity, and the type of endoscopic surgery performed. For those with lumbar disc herniation, most patients feel better after a few days. However, recovery can take several weeks for patients with extensive bone spurs, scar tissue in multiple levels of their pine, and slipped discs. Most patients can return to light-duty work in 2-3 weeks and full-duty work in 6 weeks. Be sure to follow all instructions in order to minimize the risk of postoperative complications.
What are the risks of endoscopic spine surgery?
While endoscopic spine surgery is a less invasive surgical technique, it is still a surgical procedure and has some risks and complications. The most common risks of ESS include nerve damage, bleeding, and infection. If you have concerns about these possible complications, be sure to ask Dr. Porter during your consultation.
What are the benefits of endoscopic spine surgery?
Open spine surgery requires large incisions through muscles and soft tissue in order to access the spine. During endoscopic spine surgery, the surgeon makes a small incision — typically about a ¼ inch long — to reach the affected part of the spine. Using an endoscopic camera and a monitor, the surgeon can see exactly where they are working in the patient’s spine at all times.
What is the difference between endoscopic spine surgery and open spine surgery?
Open spine surgery requires large incisions through muscles and soft tissue in order to access the spine. During endoscopic spine surgery, the surgeon makes a small incision — typically about a ¼ inch long — to reach the affected part of the spine. Using an endoscopic camera and a monitor, the surgeon can see exactly where they are working in the patient’s spine at all times. Additionally, the endoscopic spine surgery success rate is similar to or equal to the success rate of traditional spine surgery, about 90%
Does endoscopic spine surgery leave a scar?
Endoscopic spine surgery requires a small incision in the back above the location of the affected portion of the spine. This incision may leave a small scar. However, because the incision is small (about the size of a dime), the scar will be very small.